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Evaluation of the Impact of the Accelerating Children’s HIV/AIDS Treatment (ACT) Initiative on Pediatric and Adolescent
HIV Testing and Yield in Western Kenya
26 July 2017
N. Okoko1, A.R. Mocello2, J. Kadima1, J. Kulzer2, G. Nyanaro1, C. Blat2, M. Guzé2, E. Bukusi1, C.R. Cohen2, L. Abuogi3, S.B. Shade4
1. Kenya Medical Research Institute (KEMRI), Nairobi, Kenya 2. Department of Obstetrics, Gynecology and Reproductive Sciences, University of
California, San Francisco (UCSF), CA, USA 3. Department of Pediatrics, University of Colorado, Aurora, CO, USA 4. Department of Epidemiology and Biostatistics, UCSF, CA, USA
IAS#: A-‐854-‐0221-‐03721
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No conflicts of interest to declare
Conflict of Interest
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Background
Despite decreasing new HIV infections, pediatric HIV remains substantial
§ 150,000 annual new HIV infections globally (<15 years) § 1.8 million children living with HIV (<15 years) § < 30% of children tested in Nyanza region of Kenya § HIV testing -‐ gateway to achieving 90-‐90-‐90
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What was ACT?
CAMEROON
DEMOCRATIC REPUBLIC
OF CONGO
KENYA
TANZANIA
MALAWIZAMBIA
ZIMBABWEMOZAMBIQUE
LESOTHO
Accelerating Children’s HIV/AIDS Treatment (ACT)
Strategic response to treatment gap
Ini5ate 300,000 with HIV on treatment in 9 priority countries in 2 years
ACT is a public-‐private partnership between PEPFAR and CIFF
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Examine whether activities under the Accelerating
Children’s HIV/AIDS Treatment (ACT) initiative increased testing and identification of children
with HIV
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Methods
§ Family AIDS Care & Education Services (FACES) § KEMRI & UCSF collaboration
§ Comprehensive HIV prevention, care, and treatment program
§ 144 health facilities supported § Migori, Homa Bay, and Kisumu
counties
§ Nyanza region of Kenya
§ Evaluation timeframe § October 2015 – September 2016
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Health Facilities
Characteristics
85% rural Peri-‐urban 8% 6% urban Health dispensaries 66% 26% comprehensive outpatient Sub county hospitals and county referral hospitals 8%
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Intervention Steps for Pediatric/Adolescent Testing
Additional HIV counselors Create HTC space
Family testing focus: Family Information Table (FIT) utilization FIT chart audits
Community outreach testing HIV-‐exposed infants’ caregiver text
messages
Integrated intervention steps
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Evaluation Methods
Design
• Convenience sample of clinics
• Sites assigned to intervention vs. control dependent on whether the intervention was actively being implemented in a given month
• This allowed determination of impact of individual intervention
Data Collection
• Facility level • Tracking logs • Number tested • Number HIV positive • Infants <18 months • Children 18 months – 9 years
• Adolescents 10 years – 14 years
Analysis
• Intervention and control sites compared
• Negative binomial generalized estimating equations
• Adjusted for repeated measures, geographic location, health facility tier, and test kit stock-‐outs
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Results: HIV Testing
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Results: Identification of HIV Positives
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Age Group October 2015 September 2016 p-‐value
Mean number tested per facility per month
< 18 months 2.8 7.2 <.0001
18 months to 9 years
44.8 142.0 <.0001
10-‐14 years 30.1 123.3 <.0001
Mean number identified HIV positive per facility per month
< 18 months 0.06 0.37 <.0001
18 months to 9 years
0.34 0.62 0.002
10-‐14 years 0.17 0.26 0.03
Results
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Age Group Intervention IRR, 95%CI p-‐value
Infants <18 months Family Information Table 2.89 (1.53, 5.49) <0.001
Children 18 months to 10 years FIT chart audits 2.15 (1.36, 3.40) <0.001
Adolescents 10 to 14 years
HTC space improvements 1.45 (1.09, 1.93) <0.01
Successful Interventions on HIV Testing*
*Adjusted for repeated measures, geographic location, health facility tier, and test kit stock-‐outs
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Age Group Intervention IRR, 95%CI p-‐value
Infants <18 months Family Information Table 8.71 (1.45, 52.4) 0.02
Successful Intervention to Increase Identification of HIV Positives
*Adjusted for repeated measures, geographic location, health facility tier, and test kit stock-‐outs
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Family testing works
Creating HTC space boosts adolescent testing
ACT interven5ons -‐> Large tes5ng gains & HIV+ yield
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Recommendations
§ Optimize the family unit to increase testing reach and
care cascade entry
§ Don’t let the untested slip away, track closely and
conduct chart audits for follow up
§ Consider structural improvements to facilitate testing,
especially among adolescents
§ Try multi-‐faceted approaches to test children and
adolescents
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Acknowledgments
§ Ministry of Health (MOH)
§ Family AIDS Care and Education Services (FACES)
§ Kenya Medical Research Institute (KEMRI)
§ University of California, San Francisco (UCSF)
§ Children’s Investment Fund Foundation (CIFF)
§ FACES staff, clients and families
REPUBLIC OF KENYA MINISTRY OF HEALTH
!
Learn more at: www.faces-‐kenya.org